Healthcare Provider Details

I. General information

NPI: 1487653861
Provider Name (Legal Business Name): KEVIN J BERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 MERRIMACK ST STE. 2D
METHUEN MA
01844-5870
US

IV. Provider business mailing address

380 MERRIMACK ST STE. 2D
METHUEN MA
01844-5870
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-0234
  • Fax: 978-794-0560
Mailing address:
  • Phone: 978-794-0234
  • Fax: 978-794-0560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number48471
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number48471
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: